Anaesthetic Safety Checklist

Pre-Induction
Patient NAME, owner CONSENT & PROCEDURE confirmed
IV CANNULA placed & patent
AIRWAY EQUIPMENT available & functioning
Endotracheal tube CUFFS checked
ANAESTHETIC MACHINE checked today
Adequate OXYGEN for proposed procedure
BREATHING SYSTEM connected, leak free & APL VALVE OPEN
Person assigned to MONITOR patient
RISKS identified & COMMUNICATED
EMERGENCY INTERVENTIONS available

Pre-Procedure — Time Out

Patient NAME & PROCEDURE confirmed
DEPTH of anaesthesia appropriate
SAFETY CONCERNS COMMUNICATED

Recovery
SAFETY CONCERNS COMMUNICATED
Airway, Breathing, Circulation (fluid balance), Body Temperature, Pain
ASSESSMENT & INTERVENTION PLAN confirmed
ANALGESIC PLAN confirmed
Person assigned to MONITOR patient

This checklist was written by the AVA with design and distribution support from
Recommended Procedures

Pre-Anaesthesia Anaesthetic Machine

Has anything significant been PRIMARY OXYGEN source checked
identified in the history and/or BACK-UP OXYGEN available
clinical examination? OXYGEN ALARM working
(if present)
Do any abnormalities warrant
further investigation? FLOWMETERS working
VAPORISER attached and full
Can any abnormalities be
Anaesthetic machine passes
stabilised prior to anaesthesia? LEAK TEST
What complications are SCAVENGING checked
anticipated during anaesthesia? Available MONITORING
equipment functioning
How can these complications
be managed? EMERGENCY equipment
and drugs checked
Would the patient benefit from
premedication?
Drugs / Equipment
How will any pain associated
with the procedure be • Endotracheal tubes (cuffs checked)
managed? • Airway aids (e.g. laryngoscope,
How will anaesthesia be urinary catheter, lidocaine spray,
suction, guide-wire/stylet)
induced & maintained?
• Self-inflating bag (or demand valve
How will the patient be for equine anaesthetics)
monitored?
• Epinephrine/adrenaline
How will the patient’s body • Atropine
temperature be maintained? • Antagonists (e.g. atipamezole,
How will the patient be naloxone/butorphanol)
managed in the post- • Intravenous cannulae
anaesthetic period? • Isotonic crystalloid solution
Are the required facilities, • Fluid administration set
personnel & drugs available? Drug charts & CPR algorithm
(http://www.acvecc-recover.org/)

This checklist was written by the AVA with design and distribution support from